Provider Demographics
NPI:1356199129
Name:REDMAN, CHARDANA
Entity type:Individual
Prefix:
First Name:CHARDANA
Middle Name:
Last Name:REDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BEECHTREE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1210
Mailing Address - Country:US
Mailing Address - Phone:614-981-6220
Mailing Address - Fax:
Practice Address - Street 1:165 BEECHTREE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1210
Practice Address - Country:US
Practice Address - Phone:614-981-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH32388803717313M00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility